Gloria Blackmon, RNC, BSN, LNC, LNHA, never met the young man who lost his legs, but after reading over his medical records, the compassion she felt for him was as strong as if he had been her own patient. The young man had been living in an intermediate care facility for developmentally disabled adults when circulation problems in his legs became so severe that both limbs had to be amputated. His parents sued the facility and it was Blackmon’s job, as a legal nurse consultant for their attorney, to review the records and determine if they had a valid case.
In poring over the reams of documents, she discovered signs that the staff had overlooked the classic early symptoms of circulation loss. Had they addressed the problem sooner, the young man might be walking today. Blackmon’s findings strengthened the family’s case, which led to a substantial settlement.
“It was one of those cases that spoke to my heart,” says Blackmon, principal of Blackmon & Associates, a legal nurse consulting business in Topeka, Kansas.
Although legal nurse consultants don’t work directly with patients, their behind-the-scenes work on medical-related legal cases can make a huge impact on the quality of health care patients receive.
“The most rewarding part of this work is being able to help somebody, whether we find merit in the case or help the person move on with their life by validating that the doctor and the staff did everything they could,” says Rose Clifford, RN, CLNC, a legal nurse consultant in Cynthiana, Ky.
Legal nurse consultants put their nursing backgrounds to work in the legal arena. They work on contract or on salary for attorneys, insurance companies, government agencies and risk management departments, and they can provide a variety of services. Among other things, they review records to identify standards of care, conduct research and summarize medical literature, identify and apply regulatory requirements, educate attorneys about medical issues, assist with depositions and trials, and screen initial cases to see if they have merit.
“You can draw from all your bodies of education,” comments Rosalyn Harris-Offutt, CRNA, BS, LPC, BCETS, CLNC, a legal nurse consultant in Greensboro, N.C. “No one knows medical care in terms of the service provided for patients better than nurses.”
Through her consulting business, Prima Medical Legal, Harris-Offutt is a testifying and consulting expert on medical malpractice, product liability and workers compensation cases. Her background as an advanced psychiatric nurse and licensed professional counselor with expertise in post-traumatic stress disorder enables her to also testify in personal injury and criminal cases. In addition, Harris-Offutt—whose father was Cherokee and African American and whose mother was Creek Indian—strives to bring cultural competence to her consulting work. She networks with minority attorneys to serve their clients and provides consulting to Native Americans both on and off reservations. “That work is important to me because it allows me to serve all my people,” she explains.
“Many people think it’s a new specialty, but nurses have been doing legal consulting for decades,” says Donna Cardillo, RN, a career adviser and creator of “Career Alternatives for Nurses,” an audio and video cassette educational program.
The field has grown more prominent in the last 10 to 15 years as more nurses have gone into full-time private practice and demand for their services has risen. “Lawsuits definitely have been on the rise, and nurses are also looking for alternatives to bedside nursing,” Cardillo points out. Nurses’ specialized knowledge and experience are highly regarded and respected in the legal arena, she adds.
The American Association of Legal Nurse Consultants (AALNC), founded in 1989 and headquartered in Glenview, Ill., has more than 4,000 members. Another professional association, the Houston-based Medical-Legal Consulting Institute, Inc., claims to have trained more than 20,000 legal nurse consultants since it was founded in 1985 by Vickie Milazzo, RN, MSN, JD. Yet many nurses remain unaware of the opportunities this specialty offers.
“A doctor told me I’d be very good at this, but at the time I didn’t know what she was talking about,” recalls Rosie Oldham, RN, DS, LNCC, president of the AALNC. She had been a director of nursing at a children’s psychiatric hospital, responsible for risk management and quality improvement, when she heard about legal nurse consulting. After researching the field and networking, she started her own business, R & G Medical Consultants, Inc., in Phoenix, which now employs three nurses plus 15 who work as independent subcontractors. Oldham works with attorneys and insurance companies on cases involving medical malpractice, toxic torts and product liability; she specializes in large class-action suits, which can involve hundreds of individual cases at a time.
One of the greatest rewards of the work, Oldham says, is the knowledge that she is making a difference. For instance, there was the case that involved a 45-year-old woman who had died because the abnormal results of her mammogram were never relayed to her doctor. One year after the test, her cancer was discovered, but by then it was too late. Through Oldham’s research of the medical records, she was able to determine that someone had filed the mammogram results away before the doctor had a chance to see them. As a result of that case, Oldham says, Phoenix-area hospitals changed their notification procedures for mammogram results. Now hospital radiology departments, which used to notify only the doctors’ offices when there was an abnormality, also notify patients of the test results and direct them to their physicians.
An important part of Blackmon’s career is the work she does for advocacy groups for the elderly. These groups represent medically underserved clients who have little or no financial resources and whose cases would probably not be addressed without the assistance of attorneys and expert consultants who are willing to work pro bono or on a sliding fee scale. While Blackmon says she approaches this work with the same level of objectivity that legal nurse consultants must bring to all their cases, these special efforts provide the extra reward that comes from helping people whose voices might otherwise go unheard. “The same assistance legal nurse consultants bring to the legal world needs to be brought to the pro bono and advocacy world as well,” she believes.
The work that legal nurse consultants do varies according to their interests and backgrounds. “I love what I do,” Oldham asserts. “Every case is different, so you never get bored.”
Blackmon became a legal nurse consultant five years ago after working in nursing management at long-term care facilities. In her consulting work, she focuses primarily on long-term care and rehab nursing issues. Much of her work involves reviewing patient records to determine what really happened. The work is intense and full of surprises.
“Every record I receive is like a mystery novel,” she says. “You never know the answer until you get to the last page. Sometimes I’ll find something in a lab report that makes me go back and realize that the case is much more complicated than I first thought.”
A patient fall, for instance, at first may appear to be a case about whether a facility took proper safety precautions. But the records may reveal that it was, in fact, related to overmedication of the patient.
Legal nurse consultants work in a variety of settings as well. About half of the AALNC’s members are in independent practice, 25% work in law firms and another 25% are employed in industry, government, HMOs, hospitals or insurance companies. Many legal nurse consultants work part-time when they are first getting started and then switch to full-time once they have built a client base, according to the association.
Milazzo says fees range from $60 to $150 an hour for independent legal nurse consultants, while salaries for LNCs who work for employers are comparable to nursing salaries in a clinical setting.
Legal nurse consultants must be RNs, and Milazzo recommends that they have at least three years of nursing experience. They can become trained and certified in legal nurse consulting through the AALNC or other educational programs, such as Milazzo's institute. (See “The ABCs of Legal Nurse Consulting.”) But certification isn’t mandatory.
Both Clifford and Blackmon say the education and mentoring they received through the Medical-Legal Consulting Institute gave them the tools to get started in the field. But nurses should shop carefully before they spend money on LNC training. They should make sure the programs are nursing-based, Oldham advises, and run by legal nurse consultants. Some paralegal training programs market themselves to nurses, but they train students to do paralegal work, which pays less than legal nurse consulting and includes legal areas that have nothing to do with health care, such as divorce.
Cardillo thinks the opportunities in legal nurse consulting are greatest for nurses who work as independent contractors: “I know many nurses who have built successful [LNC] practices, and they tell me they have more work than they know what to do with.”
Milazzo adds that the door is wide open, whether nurses want to work for employers or independently. However, those working for themselves, she notes, have greater autonomy and never have to worry about being downsized. “There’s no limit. You can take it wherever you want to go.”
But success doesn’t happen overnight. “Just like any consulting practice, you have to build a business and develop a clientele,” Cardillo emphasizes. And that’s not always easy.
“Nurses aren’t taught how to be businesswomen and businessmen,” Blackmon says. “There is a language of business and behavior of business that is brand new to us. Legal nurse consultants often find that the marketing aspect of the business can be challenging.”
Clifford agrees. Starting a business was scary, she relates: “I hate making cold calls.”
Clifford worked nine years as a consultant for a law firm before starting her own business six years ago, focusing on medical malpractice, Medicare fraud and product liability. She has built a client base mostly through word-of-mouth referrals. She also strategically places ads in legal journals and keeps her name in play by producing a newsletter that provides snippets of useful information for attorneys.
Because of this entrepreneurial focus, legal nurse consulting isn’t for everybody. To thrive in the specialty, nurses should be self-starters, strong communicators and have highly tuned critical and analytical thinking skills. Some cases are obvious, Harris-Offutt says, but many require reading between the lines to find hidden nuances.
Persistence is critical, not just in unraveling cases but in building a business, according to Milazzo. She feels that “it’s important to feel passion about what you’re doing. That’s what will help you make it through the rough times.”
Blackmon says nurses who decide to go into business for themselves as legal nurse consultants also need to be realistic, and shouldn’t enter the specialty just for the money. Although independent LNCs can make more than $100 per hour in some areas, they also have to bear the expenses of running an office, subscribing to industry magazines and training a staff. What’s more, the workload can fluctuate dramatically. “The work doesn’t come in regular eight-hour shifts,” Blackmon explains. “You will either have so much work you can’t see straight or you’ll have no work at all. There are times when I work 12, 14, even 16 hours a day, but there are also days when I have very few billable hours.”
Does legal nurse consulting sound like a career change you’d like to pursue? If so, here are some tips for how to get started in the field:
Confused by the different legal nurse consultant acronyms mentioned in this article? Here’s a quick guide to what the “alphabet soup” is all about:
LNC = Legal Nurse Consultant (general term for a nurse who has completed an education program that provides the skills needed to work as a practicing legal nurse consultant)
CLNC = Certified Legal Nurse Consultant (professional certification conferred by the Medical-Legal Consulting Institute, Inc.)
LNCC = Legal Nurse Consultant Certified (professional certification conferred by the American Association of Legal Nurse Consultants)